Westminster City Council
Resident Parking (On-Street) Application Form
Residents’ Parking and Application Form – Terms and Conditions
Introduction
This form is to be used for the application for a
resident parking permit, changes to the vehicle
or your address or for a refund.
It is important that you read these notes
carefully and complete the application form fully.
Note: Failure to complete the form in full will
nullify your application.
1. Who can apply
Only those persons whose main or sole
domestic residence is within the boundaries of
the controlled parking zones within the City of
Westminster and who hold a valid Driving
Licence, showing your Westminster residential
address may apply.
2. Qualification
Applicants are eligible to register no more than
two vehicles for the permit. However, only one
vehicle may be parked displaying the permit onstreet at any time.
The issue of a resident parking permit is subject
to verification of residency status and vehicle
ownership. Eligibility is subject to the criteria
“Documents required for your application”, (C.
Proof of Eligibility) and in Section 4 of the
application form.
If you are a new resident in the City of
Westminster and are not able to provide all the
necessary proof of residency requested in the
Section “Documents required for your
application”, (C. Proof of Eligibility) you are still
able to apply for a resident parking permit by
completing this form. You will be required to
provide with this form, as a minimum:

a property purchase document (a letter from
your solicitor confirming that you are the
legal owner of the property),

a formal tenancy agreement or a housing
association rent document;

Supported by;

a telephone bill (not mobile) or confirmation
of new telephone land line being installed; or

the vehicle insurance certificate showing the
vehicle details, your name and Westminster
address.
A temporary resident parking permit is valid for
one month. Only one temporary permit will be
issued.
You must provide the documents in Section 4 of
the application form within this one month to
allow a full permit to be issued. If the full
evidence is not provided, including your entry to
the Westminster register of electors within the
month the resident parking permit will be
cancelled without refund.
Eligibility for a resident parking permit is not
transferable. If you move house or if you
change your vehicle, you must advise us
immediately. If you fail to do so and you
continue to use the Westminster resident
parking permit then it may be cancelled without
warning. We may prosecute you if you move
out of Westminster and fail to return the permit.
If you live on a Westminster Council housing
estate, apply to your Estate Office for a housing
estate parking permit. You may also apply for an
on-street resident parking permit so long as you
meet the stated criteria for this scheme.
Warning: Estate permits are not valid if you
park on a public road.
If you have unpaid Penalty Charge Notices
(PCNs) we may refuse to issue a permit to you.
Ver nn.nn – mm/yyyy
Page 1 of 13
3. Caution
We will only issue a resident parking permit to a
resident whose main or sole domestic residence
within the City of Westminster. Westminster
City Council takes fraud and misuse of residents
parking permits very seriously and will be
carrying out verification of the information
supplied including residential and on-street
inspections and checks. Do not complete this
form unless you are eligible to qualify for an onstreet residents parking permit.
You may report potential permit fraud by calling
the City Council’s fraud hotline on 0800 028
9888. All calls are treated in the strictest of
confidence.
Westminster City Council will prosecute
those found committing fraud.
Council and other governmental agencies
are used to assist in tracing those
committing fraud or the misuse of permits.
4. How to apply
By post
Send your form with your relevant identification
documentation and payment for the period
requested to:
Respark Applications
PO Box 6100
London, SW1E 6FG
Tel: 020 7641 5123
Cheques or postal orders should be made
payable to “Westminster City Council” and
crossed “account payee”. If the bank returns
your payment unpaid, your application will not
be valid and the resident parking permit will not
be valid. If your application is not approved, it
will be returned to you with a covering letter
explaining why.
In person
You are able to apply for your residents’ parking
permit at the following Westminster offices:
One-Stop Services opening times, contact
details and their locations are as follows:
One Stop
64 Victoria Street
London SW1E 6QP
Open: 8:30am to 7pm Monday to Friday
9:00am to 1:00pm Saturday
One Stop
317 Harrow Road
London W9 3RB
Open: 8:00am to 5pm Monday to Friday
(Tuesday open until 7pm)
One Stop
91-93 Church Street
London NW8
Open: 8:00am to 5:00pm Monday to
Friday
9:00am to 3:00pm Saturday
You must bring all the relevant documents with
you. If paying by cheque please make this
payable to Westminster City Council. Credit
card payments are accepted at our One Stop
Services. Please note that we do not accept
American Express or Diners Club cards.
If the bank returns your payment unpaid, your
application will not be valid and the resident
parking permit will not be valid.
If your application is not approved we will tell
why at the time of your visit.
5. Scheme Information
To prove your entitlement to park, a valid
residents permit must be clearly displayed
on the passenger side of the windscreen at
all times. If you use a bike display the permit
on the nearside.
DO NOT send cash through the post.
Please note that until you receive your
residents parking permit you will not be
allowed to park on-street unless you pay to
park on a meter or pay and display bay.
Enforcement action will be taken if a valid
permit is not displayed. Eg. Immediately
upon expiry of the current resident parking
permit.
Ver nn.nn – mm/yyyy
Page 2 of 13
Having an on-street parking permit does not
guarantee that there will be a parking space
available for you at any place or at any time.
Suspensions
We will usually warn you if on-street parking is
going to be disrupted or suspended, although
this is not always possible. We will normally put
up notices at or near the relevant resident
parking spaces before the start of the day’s
restrictions. Please make sure that your vehicle
is not parked in a place where parking has been
suspended, as it may receive a PCN and have
to be removed. You may check for pending
suspensions by ringing 020 7641 6850
New suspensions are usually introduced
overnight, coming into operation at 8.30am.
Emergency suspensions may be introduced at
any time of the day. All suspensions apply for 24
hours a day. Please remember it is your
responsibility to check your vehicle before
8.30am each morning to make sure parking is
not suspended. If you cannot check yourself,
you should arrange for someone to check, and
move your vehicle if necessary.
Holiday Parking
The City Council operates a Holiday Parking
Scheme that enables an on-street resident
permit holder to use a selected off-street car
park, operated by Masterpark. A minimum
period of stay and a nominal daily charge
applies and you will need to ‘book’ you space in
advance. Full details and bookings are available
by calling 0800 243348.
Unique Reference Numbers
There will be occasions where a resident will be
using a ‘courtesy’ or ‘hire’ car, following a road
accident. A Unique Reference Number (URN)
can be issued and must be displayed with your
current permit in the loan or new vehicle. A URN
is valid for a maximum of seven days and is not
renewable. Please call 020 7823 4567 if you
should need to obtain a URN.
this document is available from the City
Council’s web site at: www.westminster.gov.uk
6. Data protection statement
Westminster City Council and its agents will
process your information primarily for the
purpose of providing parking services to users:
residents, businesses and visitors. We may also
use your information to prevent and detect fraud
and to protect public funds. This will also include
the recording of vehicle information and
verifying residency status and parking
entitlements both within and outside of the
borough. We may therefore disclose or request
your information from the Driver and Vehicle
Licensing Agency (DVLA), law enforcement
agencies and other organisations, such as other
local authorities. We will use a number of
means to ensure the lawfulness of the use of
our parking services. This will include the use of
surveillance equipment, parking attendants,
auditors and dedicated investigators to record
data. In line with its duty to protect public funds
the Council and its agents will undertake
investigations involving the random auditing of
vehicles and users who hold a valid parking
permit to counter suspected fraudulent use of its
parking services.
If you wish to complain at the manner in which
your personal data has been processed or
maybe used you should write to the:
Data Protection Officer
Westminster City Council
64 Victoria Street
London SW1E 6QP
The City Council operates a separate schemes
offering off-street parking at our MasterPark
branded multi-storey car parks. For further
information residents can contact 0800 243348
for application details. Non-residents should
contact the commercial team on 020 7641 2065.
Web Access
Information relating to the resident parking
permit scheme including electronic versions of
Ver nn.nn – mm/yyyy
Page 3 of 13
Instructions
B. First time applicants
Welcome to Westminster’s
resident parking scheme
If this is your first application for a resident
parking permit we will ask you to provide your
previous address. We may use this information
to check with other Local Authorities to ensure
the validity of your application and to verify that
you have returned any resident permit issued by
another authority.
The City of Westminster has been divided into 8
different resident parking zones, (A-H). Full
details of where you can park and the hours that
parking is controlled will be given to you with
your permit. Your permit will be valid for the
zone in which you live.
C. Proof of eligibility
A. Types of Permit
You must provide originals in your name and
showing your Westminster address of the
following documents:
You may apply for a yearly permit which is valid
for 12 months. The cost for an on-street permit
is £100 (discounted rate £70 for vehicles under
1200 cc).

Your driving licence; and

The vehicle registration document (V5 or
V5C) or the vehicle lease / hire agreeement;
and

Your certificate of vehicle insurance.
Charges for on-street resident parking permits
are reviewed each year.
The City Council is able to offer discounted rate
permits for environmentally friendly vehicles. If
your vehicle is 1200cc or less or is powered by
liquid petroleum gas (L.P.G.), which must have
been fitted by an approved dealer, or electricity,
the discount may apply. Please ask for more
information. Any discount offered will only apply
on first application or renewal of your permit.
Where you have two vehicles on your permit
then the higher charge will apply unless both
vehicles meet the above criteria.
For a British, Commonwealth or EU citizen your
name must appear on the Westminster electoral
register. For those who are not a British,
Commonwealth or EU citizen then you must
provide your passport as confirmation that you
are not eligible to be included on the electoral
register.
You must also provide two items from the
following:
Temporary permits

The current council tax demand; or
If you are a new resident and you are unable to
provide full proof of eligibility, we may provide a
temporary permit for one month while you
arrange to change your address on any
documents that we require is support of your
application.

a property purchase document (a letter on
headed note paper from your solicitor
confirming that you are the legal owner of
the property); or

a formal tenancy agreement or a housing
association rent document; or

A recent, (not more than three months old),
utility bill; or

A recent, (not more than three months old),
telephone (landline) bill, (mobile phone bills
will not be accepted); or
A temporary permit will be charged at the full
yearly rate of the permit. No further charge will
be incurred when you provide the documents
within the agreed period. If, however, you do not
meet the full eligibility within the time allowed
you will not get a refund for the unused portion
of the permit.
Ver nn.nn – mm/yyyy
Page 4 of 13

A recent, (not more than three months old)
personal bank or building society or credit
card statement. Company accounts will not
be accepted.
If you have just moved into Westminster we will
need to see the original of either a property
purchase document or tenancy agreement.
Full proof of eligibility must be provided each
time you apply for a permit.
If your vehicle is registered abroad, please
contact us for more information. You will find our
phone numbers and address in the ‘Instructions’
section of this leaflet.
If you hire, lease or rent a vehicle from a
recognised company, the agreement must show
your name and your Westminster address. If
you use a company vehicle, you must show us
proof that you are the user, as set out in
instruction E below.
Chauffeur
In the case of Westminster residents who
employ a chauffeur to drive their vehicle and do
not hold a driving licence, the following
conditions would apply for a permit application,
which must still be made by the resident. The
resident must make the application and must
produce:
 the vehicle registration document (V5 or
V5C) showing their Westminster address;
 the resident must prove residential eligibility
through the usual means;
 the resident must provide either the contract
of employment or a payslip for the employee
who drives their vehicle;
 the resident must provide the certificate of
insurance for the vehicle(s) naming the
employee as the main driver;
 the employee must provide a valid full
driving licence;
 only one vehicle will be shown on the permit;
and
 the resident must return the permit if the
person employed as the chauffeur leaves
their employment.
D. Conditions of use
Your vehicle must be roadworthy throughout the
life of the resident parking permit. Where a
vehicle is considered as not being roadworthy,
(e.g. following an accident) the permit may be
withdrawn and the vehicle removed.
Your vehicle must display a valid road fund
licence throughout the full period of the resident
permit. If the road fund licence is expired the
permit may be withdrawn and the vehicle
removed.
In the cases of roadworthiness and the
displaying of a valid road fund licence the City
Council or its agents will aim to write to you
before a resident parking permit is withdrawn to
allow you time to remove the vehicle. Any costs
incurred by the Council will be passed to the
keeper.
Your vehicle must be able to fit in the parking
place, and be:

a passenger vehicle which cannot carry
more than 13 people (including the driver);

a vehicle that does not exceed 6 metres in
length;

a vehicle which is not more than 2.44
metres (8 feet) high.
You must not park trailers or caravans in a
resident parking place.
E. Proof that you own or use the
vehicle
Private vehicles
Whether you’re a new applicant or when
renewing your current permit you must show us
the original vehicle registration document (DVLA
form V5 or V5C), not a copy. If you hire, lease or
rent the vehicle, you must show us the original
lease or rental agreement, not a copy of it.
Company vehicles (Limited Companies)
If you work for a limited company, and your
company owns the vehicle, you must:
Ver nn.nn – mm/yyyy
Page 5 of 13

provide a copy of the vehicle registration
document (DVLA form V5 and V5C); and

provide a recently dated letter dated within
the last month (not a copy) on company
letterhead paper, addressed to Westminster
City Council and confirming your name and
Westminster address and that the vehicle is
provided by the company for:
a) your sole use and keepership for
business;
b) private and domestic use; and
c) that the vehicle is not provided for
business use to any other company
employee (i.e., that it is not a pool car).
A senior representative of your
company who must not be related to
you must sign this letter.
If your company leases the vehicle, as well as
the letter, you must give us a copy of your
company’s lease agreement instead of the
vehicle registration document.
Company vehicles (non-limited companies)
If you work for a non-limited company, and the
vehicle is owned by your company, you must:

provide a copy of the vehicle registration
document (DVLA form V5 or V5C); and

provide a sworn statutory declaration
dated within the last month, signed by a
senior representative of your company, in
the presence of a Solicitor / Commissioner
of Oaths, who must not be you or related
to you, confirming that the vehicle is
provided by the company for:
a) your sole use and keepership for
business;
b) private and domestic use; and
c) that the vehicle is not provided for
business use to any other company
employee (i.e., that it is not a pool car).
If you are a sole trader, please contact
us for more information about filling in
the sworn declaration.
For a copy of the declaration, please visit
any of the One Stop Services listed on the
‘Instructions’ page
If the vehicle is leased by your company, as
well as a sworn statutory declaration, you must
give us a copy of your company’s lease
agreement instead of the vehicle registration
document. The permit expiry date will not
extend beyond the expiry date of the lease
agreement.
F. Renewing, updating, replacing
or returning your permit
Renewing your permit
Please fill in sections 1, 2, 3, 4 and 9 on the
application form and return the form
immediately, with your payment and all the
documents listed in instruction C and E above
which apply to you.
If you change your vehicle
If you change your vehicle while your permit is
valid, fill in sections 1, 2, 4, 5, and 9 on the
application form and bring the form to any of the
One Stop Services with your permit. If you
cannot visit us immediately, you may phone
Parktel on 020 7823 4567 to get a 7-day
authorisation allowing you to use your old permit
on your new vehicle but you must get a new
permit within this period. You must post to
Respark Applications (the address is on the
‘Introduction’ page), or bring to any of the One
Stop offices, the proof we ask for in instruction E
within three months of changing the vehicle.
An administration fee of £30 will apply.
If you change your address
If you move to another address in the same
parking zone, you can continue to use the same
permit, but you must inform us promptly so that
we can update our records. You will need to
provide the proof we ask for in Instruction C
when you renew your permit.
If you change your address to a different zone
please fill in section 1, 2, 3, 4, 6 and 9 on the
application form and return it to us with your
permit. You will need to provide the proof we
ask for in instruction C and E.
An administration fee of £30 will apply.
Ver nn.nn – mm/yyyy
Page 6 of 13
If you move out of Westminster you must return
your permit immediately, (see ‘Returning your
permit’ below).
If you fail to inform Westminster City Council of
a change of address your permit will be invalid
and we may take enforcement action.
Fill in the application form in block capital letters,
using a black pen.
Don’t forget to tick the appropriate boxes in
declaration B, section 13. Every applicant must
sign and date this declaration.
Unsigned applications or those signed by
anyone other than the applicant will be refused.
Replacing your permit
We will provide a replacement if you lose your
permit or it is stolen. We will cancel the original
permit when we issue the replacement. Please
fill in sections 1, 2, 7 and 9 on the application
form. If you find your permit after we have
replaced it, you must return it to us. Details of
lost or stolen permits are passed to our permit
investigations team.
An administrative fee of £30 will apply, which
will be reduced to £25 where a crime reference
number is provided.
Returning your permit
If you return your on-street residents parking
permit to us because you do not need it, we will
provide a refund for each day you will not be
using it. To reduce costs refunds are paid by
automatic credit transfer to you bank account.
Please fill in sections 1, 2, and 8 of the
application form. We cannot pay the refund to
anyone other than the person whose name is on
the original application.
Tear off the application form and keep these
notes and instructions in a safe place for future
reference.
Make sure you provide any documents needed
to support your application and bring or post
them with your application.
Don’t forget to enclose your cheque or postal
order.
If you go to any of the One Stop Offices, your
application will be dealt with while you wait, as
long as all supporting documentation is in order.
If you prefer to post your application, we will
deal with it within 24 hours of it reaching us as
long as all documentation is in order.
Refunds will not be considered unless the
permit is surrendered.
G. Filling in your application
If you have any questions, please get in contact
with the addresses that are on the ‘Instruction’
page.
Ver nn.nn – mm/yyyy
Page 7 of 13
Resident parking permit application form
Please tick all the relevant boxes and fill in all the details we ask for.
Please write in capitals and use black ink.
Please confirm that this is a:
For office
use only
first time application
permit renewal application


permit replacement request 
change of address

Section 1 (see Introduction 1 and 2 and Instruction B)
A.
ABOUT YOU (This section must be completed on all occasions)
Title (e.g.: Mr Mrs Miss Ms)
: _______________Other: ___________
Surname
: ___________________________First Name: ________________
Address
: _____________________________________________________
NAM

ADD

: _____________________________________________________
: _____________________________________________________
: __________________________Post Code: _________________
Home Telephone
: ____________________________
HT

Daytime Contact
: ____________________________
DC

Mobile Phone Number
: ________________________________
MP

Prev

HT

DC

MP

Previous Address
If you are a first time (new) applicant you must provide your previous address here. We will check
the details you give us including verifying if you already have a resident parking permit.
B.
Your previous address
Title (e.g.: Mr Mrs Miss Ms)
: _______________Other: ___________
Surname
: ___________________________First Name: ________________
Address
: _____________________________________________________
: _____________________________________________________
: _____________________________________________________
: __________________________Post Code: _________________
Home Telephone
: ____________________________
Daytime Contact
: ____________________________
Mobile Phone Number
: ________________________________
Ver nn.nn – mm/yyyy
For office
use only
Section 2 (see Instruction E)
Vehicle Details
Please tick appropriate boxes
Is the vehicle a:
Car

Van

Motorcycle
Vehicle No. 1


VRM

MaM

Col

CC

Hei

Lgh

GV

Fuel

Vehicle No 2
Vehicle registration number
: _________________ : _________________
Make (e.g.: Ford)
: _________________ : _________________
Model (e.g.: Focus)
: _________________ : _________________
Colour
: _________________ : _________________
Engine Size (CC rating)
: _________________ : _________________
Is the vehicle over 2.44 metres (8 feet) high?
Yes

No

Is the vehicle in excess of 6 metres in length?
Yes

No

Is it a goods vehicle?
Yes

No

Is the vehicle powered solely by LPG or electricity?
Type
Yes

No

Section 3 (see Instruction A)
I want to apply for:

a yearly (12 month) permit:
YRL
£100

£70

REN

For a new application my parking permit should start on: ______ / __________ / ______
If this is a renewal the start date will be the day following the expiry date of your current permit.
Please confirm your current permit number:
__________________
(You will find this on the front of your existing permit. The permit number will normally start with
either a Q or a Y and is immediately below the expiry date)
Ver nn.nn – mm/yyyy
Page 9 of 13
For office
use only
Section 4 (see Instruction C and E)
Proof of Eligibility Westminster Residency and Vehicle Ownership
ER
Please tick appropriate boxes

I am a British, Commonwealth or EU citizen and on the Westminster Register of Electors

Ref

PPT
I am not a British, Commonwealth or EU citizen as confirmed by my attached passport

VRD

DL

You must provide the originals in your name and showing your name and Westminster address of the
following:
Vehicle Registration Document
Certificate of motor insurance

Driving Licence

Vehicle Lease / Hire agreement

CMI

VL
HA
And two documents from the following list:
Council tax demand (Current)

Bank Statement

Water Rates

Property lease agreement

Telephone bill*

Gas Bill

Benefit or Pension Book

Electricity Bill

Property purchase document

Tenancy Agreement

* We do not accept a mobile telephone bill
CT
BS
WR
PLA
TB
GB
BPB
EB
PPD
TA













For an application in regard to Chauffeur staff you must also provide:
Contract of employment or payslip

Employee’s Driving Licence

CE
PS
EDL
Section 5 (see Instruction F)



Change of Vehicle
I want to change the vehicle registration number:

Current Registration Number(s): ______________________________________
New Registration Number(s):
COV
VRM
______________________________________
VRM
The new vehicle details must be shown in Section 2.
Attach your current permit so that we can replace it and include you payment of £30.



Fee
£30

COA

PRM

Fee
£30

Section 6 (see Instruction F)
Change of Address
My address has changed and I need to change the zone of the resident parking permit.

The new address details should be shown in Section 1 and you must provide proof of eligibility as
shown in Section 4
Attach your current permit so that we can replace it and include you payment of £30.
Ver nn.nn – mm/yyyy
For office
use only
Section 7 (see Instruction F)

I need to replace my permit:
Please tick appropriate boxes
The original has been:
lost?

stolen?

damaged?

Vehicle registration 1: ___________________________
REP

LT
ST
DA



CRN

POL

Vehicle registration 2: _____________________________
If the permit has been damaged it must be attached and returned with this form and include your
payment of £30
If the permit was stolen you must provide your payment of £25, a police crime reference and the
police station name:
Crime Reference Number: __________________________
Police Station: ____________________________________
Please give brief details about the loss or damage:
________________________________________________________________________________
________________________________________________________________________________
Fee
£30
£25


________________________________________________________________________________
________________________________________________________________________________
Section 8 (see Instruction F)

I no longer require the permit and want a refund
RFD

ADD

Your permit must be attached to this form for a refund to be considered.
To reduce costs refunds are paid by automatic credit transfer to your bank account. We cannot pay a
refund to anyone other than the person whose name is on the original application form.
Please send any refund to my bank account as detailed below.
Bank Name: __________________________________
Account Name: ____________________________
Sort Code: _____________
Account Number: ______________
Your Correspondence address:
Val
________________________________________________________________________________
________________________________________________________________________________
£____
_______________________________________________________Post Code_________________
Ver nn.nn – mm/yyyy
Page 11 of 13
Section 9
Declaration
The applicant named in Section 1 must sign this Declaration
You must read each paragraph of the following declaration very carefully and tick each box to confirm that you have
read and understood it. Warning: It is an offence to give false or misleading information. If you do, you may
be prosecuted and ordered to pay a fine of up to £2,500. Failure to abide by the terms and conditions of the
season ticket may lead to prosecution and you could receive a fine of up to £5,000. (If the case goes to the
Crown Court, the maximum penalty is an unlimited fine or two years in prison, or both).
I certify that:
Tick Boxes
The Westminster address shown in Section 1 of this form is my sole or main domestic residential address as
defined in the resident Parking Permit Application Form introduction and instruction attached and, that the
motor vehicle(s) with the registration numbers given in Section 2 are kept and used by me.
The Resident Parking Permit is issued for the sole use of the applicant and is not transferable to any other
person, or vehicle (except where a Unique Reference Number – URN has been issued for the purposes as
described in Introduction 5 - is clearly displayed).
I undertake to notify the City of Westminster of any changes in my personal circumstances that may affect the
validity of my resident parking permit, (i.e: Change my address in, or move out of, the City of Westminster).



I understand and accept that the Resident Parking Permit remains the property of Westminster City Council
and I will return it to them if there is any relevant change in my circumstances, for example, if I change my
address. I will also return the resident parking permit if I am asked to do so by a Council Officer or authorised
agent.

I do not hold another valid on-street resident parking permit issued by Westminster City Council, other than
the one I am renewing, or for any other local authority.

I understand and accept that my vehicle must be roadworthy and must display a valid road fund licence
throughout the life of the resident parking permit and that if I park a vehicle in Westminster in a manner that
the Council considers unroadworthy or untaxed the permit may be cancelled and enforcement action can be
taken.

I understand and accept that if I apply for a temporary permit and fail to provide the documents necessary to
support my application then I will not be granted a refund.

I understand and accept that the City Council or its agents will use the information I have provided to satisfy
itself that I am eligible for the on-street residents parking permit and/or to prevent and detect fraud

I understand and accept that you may ask to inspect my home before or after issuing a permit to make sure I
have given my correct address. If I refuse, I understand it is likely that my current permit will be withdrawn.

I have read the introduction and instructions that accompany this application form and I understand and
accept the conditions that the on-street resident parking permits are issued.

Please ensure that you have ticked all of the above boxes within this declaration and that you have signed and
dated this section. If any part of the application form has not been completed properly or the applicant fails to
tick all relevant boxes then the application will be refused. The applicant will be required to re-sign this form.
Warning: The information I have provided in this application form is true and accurate. I
understand and accept that if I have stated anything that I know to be wrong, or untrue, or
subsequently found to be wrong, I may be prosecuted.
Signature: _______________________________ Date: ______ / __________ / ______
Print Name: ______________________________
Ver nn.nn – mm/yyyy
Page 12 of 13
Notes to the applicant:
Please ensure that all the information you have provided is correct and that you have included any original
documents to support your application, this will assist you receiving, and the City Council or its
authorised agents issuing, the correct permit promptly.
You must have read and complete the declaration(s) in Section 9.
The City Council wishes to prevent fraudulent applications and reserves the right to issue a permit for one
month while new applicants arrange to change the address on the vehicle registration document and/or
other documents (utility bills for instance) or so that an Enforcement Officer can complete a check of the
residence. In such cases the monthly permit will be charged at the full rate.
WARNING: The giving of false or misleading information by the applicant or can lead to legal action being
taken against all parties.
Section 10
Issuing Officer name: __________________________
FOR OFFICAL USE ONLY
Location: ____________________________________
Date Application Received:
_______________
Initials
Supervisor Checked: ___________________________
Permit Details
Residency Check Completed:
_________
Computer / Manual: ___________________________
Driving Licence Checked:
_________
Permit Number: ______________________________
Vehicle Insurance:
_________
Permit Security Number: _______________________
VRD Checked:
_________
Start Date: ____________ End Date: ____________
Other ID verified (Specify Doc’s)
Zone: ________
________________________________
Date Issued to applicant: ________________________
________________________________
Referred to Investigations: ______________________
________________________________
Reason: _____________________________________
System checked for outstanding PCNs
Y/N
___________________________________________
Reason for declining application: _________________
___________________________________________
___________________________________________
___________________________________________
___________________________________________
___________________________________________
Ver nn.nn – mm/yyyy
Page 13 of 13